OBJECTIVE: To examine the impact of treatment setting and exposure to case management services on the quality of life of U. S. veterans with chronic and persistent mental illness. DATA SOURCES/STUDY SETTING: Data were collected longitudinally on a panel of 895 clients enrolled in 14 pilot programs in Department of Veterans Affairs long-term psychiatric hospitals by the Serious Mental Illness Treatment Research and Evaluation Center during the period 1991-96. STUDY DESIGN: Data were collected using two primary survey instruments (clinician assessment and client assessment) at baseline, every six months for the first two years, and every year thereafter, for a total of four years of follow-up. Case management exposure over time and its impact on the client's quality of life represent the key variables in the study. Additional controls included a variety of sociodemographic, socioeconomic, and psychiatric characteristics. DATA COLLECTION/EXTRACTION METHODS: Hierarchical linear modeling was used to control for potential selection bias, test for the compositional effect of treatment setting, and examine the impact of case management exposure over time on the individual client's quality of life. PRINCIPAL FINDINGS: Increased exposure to case management results in an improved quality of life across several domains, including both objective and subjective dimensions for health, general, leisure, and social, and the subjective dimension only for housing. CONCLUSIONS: The study findings provide managers, clinicians, and policymakers a fuller understanding of how this mode of service delivery-case management-affects several domains of quality of life for clients with chronic illnesses.
OBJECTIVE: To examine the impact of treatment setting and exposure to case management services on the quality of life of U. S. veterans with chronic and persistent mental illness. DATA SOURCES/STUDY SETTING: Data were collected longitudinally on a panel of 895 clients enrolled in 14 pilot programs in Department of Veterans Affairs long-term psychiatric hospitals by the Serious Mental Illness Treatment Research and Evaluation Center during the period 1991-96. STUDY DESIGN: Data were collected using two primary survey instruments (clinician assessment and client assessment) at baseline, every six months for the first two years, and every year thereafter, for a total of four years of follow-up. Case management exposure over time and its impact on the client's quality of life represent the key variables in the study. Additional controls included a variety of sociodemographic, socioeconomic, and psychiatric characteristics. DATA COLLECTION/EXTRACTION METHODS: Hierarchical linear modeling was used to control for potential selection bias, test for the compositional effect of treatment setting, and examine the impact of case management exposure over time on the individual client's quality of life. PRINCIPAL FINDINGS: Increased exposure to case management results in an improved quality of life across several domains, including both objective and subjective dimensions for health, general, leisure, and social, and the subjective dimension only for housing. CONCLUSIONS: The study findings provide managers, clinicians, and policymakers a fuller understanding of how this mode of service delivery-case management-affects several domains of quality of life for clients with chronic illnesses.